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General NPI Number Information
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NPI Number | 1750849592
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Entity Type | Organization
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Legal Business Name | CATHOLIC COMMUNITY SERVICES OF WESTERN WASHINGTON
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 5410 N 44TH ST
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City | TACOMA
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State | WA
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Zip | 98407-3799
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Country | US
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Telephone | 253-759-9544
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 N J ST
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City | TACOMA
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State | WA
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Zip | 98403-2125
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Country | US
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Telephone | 253-761-3898
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Fax |
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Authorized Official
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Title or Position | COMPLIANCE & POLICY ANALYST
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Name | STEPHANIE M. THELEN
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Credential |
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Telephone | 253-761-3898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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